Abstract
Nosocomial transmission of multidrug-resistant Streptococcus pneumoniae (MDRSP) is rare but possible. We report a case of an older woman who developed invasive MDRSP infection acquired via possible nosocomial transmission. We aim to highlight the challenges Japan faces regarding its increasing susceptible elderly population, the low rates of pneumococcal vaccination, suboptimal adherence to standard precautions, and the possible need for transmission-based precaution policies for MDRSP.